When pharmacies administer vaccines, physicians lose an opportunity

The state legislature in Florida decided it is legal and appropriate for pharmacists and pharmacies to begin administering vaccines against multiple diseases. Their list of adult vaccines includes seasonal flu shots, Pneumovax (pneumonia vaccine) and Zostavax (vaccine to prevent shingles). The rationale of the legislature is that access to doctors to receive these preventive vaccines is limited and difficult.

By refusing to administer vaccines in their office because it is time consuming and not profitable enough, my colleagues in primary care have not made my argument against permitting this any stronger. I thought prevention and administering vaccines was part of the job description in primary care. I am not asking my colleagues to lose money, but I do believe there is a distinct difference between not making a large profit and losing money. Isn’t it our professional and ethical responsibility to provide preventive services?

Over the years, the fall season and start of the school year have always provided an opportunity to remind patients that they were due for an annual checkup and to make positive suggestions on what other opportunities were available for them to try and prevent infectious or chronic disease. School-age children have been required to receive immunizations before entering school for obvious public health reasons. This provides an opportunity to benchmark their growth and age goals and discuss healthy living as well. The visits came towards the end of the calendar year when most individuals had met their annual medical deductible so the out of pocket costs were not great.

As I walk into my local CVS I am confronted by ads for vaccines and same-day clinics. They remind me that physicians have lost this encounter to enhance the doctor/patient relationship and provide sound health advice for the future because administering vaccines isn’t very profitable. Pharmacies often use vaccinations as a loss-leader to draw you in and get you to purchase other, more profitable, items.

I will continue to provide vaccines in my internal medicine office as I believe it is the professional and responsible thing to do.

When I heard about the pharmacists starting to give injections like the flu shot that just made me cringe. And each time I see it when flu season comes around every year I get even more uncomfortable with the fact that they are doing this. Now I am even more aware after having gotten my first ever flu shot this year.

Not really sure why. When I worked a regular job, I often got flu shots at work. Over the last 10 years or so, I’ve been getting them at pharmacies. I still see my doctor at least once a year anyway.

Homeless

There isn’t any clinical evidence that annual physical exams are beneficial to an adult patient. Perhaps we could make the conclusion that all that advice doesn’t lead to a longer and healthier life.

I avoid the doctors office once school starts and the first colds of the season get passed around. Medical offices are full of germs and sitting there in the waiting room with a bunch of coughing patients isn’t my idea of staying healthy.

The pharmacy provides a convenient service and a cheaper price than the doctor’s office. No appointments, no “flu shot clinics” to fit into a busy schedule. It’s great…capitalism at work.

Maura69

A year ago I asked my physician for the Flu/Pneumonia and the Zostavax vaccines. He informed me that he would have to hire two more individuals to do the paper work and administer the vaccines. I said that I would administer it myself to help him out and get the needed vaccines. He stated, go to the pharmacy it will be easier. Needless to say that is what I do now and did then. I truthfully think my Doc needs to retire as I am doing more prescribing and locating specialists when needed. “You’re over 50 now and your hip is going to hurt”…Ah ha, previously I had a hip implant that was defective and was impinging my pelvic bone – so if I had listened to my Doc I wouldn’t be walking now…I found a Specialist had the hip replaced and now go to the gym 6 days a week, ride the treadmill, the bicycle and do cross country – I had never before been able to do that. So do we agree – my Doc needs to retire!

Tough question to answer Maura. Not enough info to tell if your physician needs to retire but what is clear that you need to establish a better professional relationship with a doctor of choice.

Maura69

Thanks for the reply Steve and your statement is completely viable. The only problem is I live in the country with few Doctors available.

Jane Berg

As someone who works in health care, I see this is as a two-edge sword. We all seek convenience in our lives and that seems (to me) to be the driving force behind allowing vaccinations to be administered by pharmacists or visiting nurses associations. It is true that preventive services are not generally big revenue markers for physicians, but is part of their training to prevent illness and disease. Physician offices setup blocks of times specifically for school physicals, flu vaccine clinics, and vaccinations in general that can be administered by a PA or a nurse (NP, RN) while allowing the physician to continue seeing other patients concurrently. Not only is there a shift in the revenue (pharmacist vs the physician), but there is also a shift in the liability that may occur from an adverse reaction to the vaccine received.

MarylandMD

A significant number of patients are now valuing convenience over continuity of care. We as physicians have to find a way to adapt to the needs and desires of our patients. Is it better to get your shots with your PCP? Yes, of course. Is it so much better that it is worth driving an extra 5-10 miles out of your way, dealing with prolonged check-in hassles, and waiting 30 minutes just to get a flu shot? Most patients would say no.

Primary care physicians still retain an advantage with most of our patients, who give us their trust and loyalty. But they are living busy lives and their patience is not limitless. The retail pharmacies have presented a challenge to the traditional medical practice. Now we have to find a way to make the process as easy and convenient as possible to retain our advantage.

The only real advantage PCP’s have today is that there is a shortage of primary care physicians and an approaching tidal wave of patients entering the health care system.

MarylandMD

I do not share your optimism.

There has been a shortage of PCPs in our state for years, yet it has not translated into better prestige, better pay, or fewer administrative hassles.

I suspect that a worsened shortage of PCPs may instead lead to the physicians being asked to see more patients, which will lead to longer waits for shots or other basic care. This will only push patients further towards convenience-based care at retailers instead of traditional primary care.

I think we need to distinguish ourselves from high volume impersonal clinics staffed by less experienced and trained staff and get the message out to the community. Whether you are in a traditional practice or a direct pay practice it is possible to do this and set yourself apart based on your care , concern and compassion. The public will find you.

MarylandMD

So the advantage is in offering a better product. Even in a glut of PCPs, it would still be that way. That was my point: a shortage of PCPs does not translate into much of anything for us, just more trouble for many patients. We PCPs have to meet our patients needs to retain their loyalty, and griping that pharmacies are giving flu shots really misses the point.